Background: Family therapy is considered as the gold standard in treatment of adolescents with anorexia nervosa (AN). Among the different types of family therapy, multi-family therapy (MFT) is increasingly used for treating AN, and shows promising results. In this article, our focus relied on the patients’ and their parents’ perceptions of the effectiveness and the underlying mechanisms of the MFT. Methods: The present pilot exploratory qualitative study included two focus groups conducted using a semi-structured approach: one with the adolescents (n= (...) 3), and another with one or two of their parents (n= 4 mothers;n= 2 fathers). The subjects discussed were the changes observed in both AN symptoms and family interactions following therapy, and the mechanisms underlying these changes. We crossed the perspectives of the adolescents and of the parents on these two points. Results: Qualitative analysis revealed that while both adolescents and parents had difficulties relating the changes they observed in the last year to MFT, they were able to say that the group cohesion had several positive effects and that their family dynamics had improved. In the light of analysis the adolescents perceived more improvements related eating disorders symptoms than their parents did, while parents were concerned about a negative effect of MFT on their children. Discussion: While both patients and parents perceived improvements in both AN symptoms and family interactions in the past year, it was not clear if they considered MFT to have led to these improvements. FG also explored the MFT mechanisms underlying changes. Both adolescents and their parents stressed the beneficial effects of identification to others members of the group and shared experience to overcome social isolation. Parents also mentioned the sympathy they felt for each other. The idea that they give a central place to families in the therapy was also described by the families. (shrink)

A new understanding of the objectifying process in science is gained if one considers it in the framework of the open, dynamical and holistic model of knowledge developed by Ernst Cassirer to overcome the problems of Kantian epistemology, which allows to consider transitoriness and contingency as integral parts of knowledge. Using physics as a concrete example it is examined, how the fundamental tasks of constitution and justification of knowledge can be understood differently within this model and to what extent this (...) allows to clarify still controversial interpretational questions (especially in quantum mechanics). Therein the creation of symbolical order -patterns and the purely pragmatic confirmation of even the foundations of knowledge are of central relevance. (shrink)

The reflection on the preconditions and evolution of science has played a decisive role in the development of Ernst Cassirer's philosophy, contributing to its functional and thus inherently pluralistic and holistic view of knowledge. To present Cassirer's conception of physics as an open symbolic formation enables us to reveal and study the radical features of his epistemological model: (1) the fundamental process of generating sense-units and meaning in its constitutive character for each attempt of objectification, (2) its driving and structuring (...) dynamics that touches and transforms all elements of knowledge, the a priori included, (3) the strategies of justification that allow maintaining the claim of truthfulness in spite the fact that Cassirer's open model integrates contingency and transitoriness as an inherent part of knowledge. It thus becomes clear that Cassirer's term 'symbol' cannot be reduced to its habitual representational acceptation, for its key theoretical function is to overcome the inconsistencies of dualistic epistemological models. It is this re-orientation, a kind of 'second Copernican revolution', that allows Cassirer to go beyond traditional dichotomies and to propose a larger frame in which to appreciate the diversity of human understanding. (shrink)

This book presents a radical and intuitive argument against the notion that intentional action, agency and autonomy are features belonging only to humans. Using evidence from research into the minds of non-human animals, it explores the ways in which animals can be understood as individuals who are aware of themselves, and the consequent basis of our moral obligations towards them. The first part of this book argues for a conception of agency in animals that admits to degrees among individuals and (...) across species. It explores self-awareness and its various levels of complexity which depend on an animals’ other mental capacities. The author offers an overview of some established theories in animal ethics including those of Peter Singer, Tom Regan, Bernard Rollin and Lori Gruen, and the ways these theories serve to extend moral consideration towards animals based on various capacities that both animals and humans have in common. The book concludes by challenging traditional Kantian notions of rationality and what it means to be an autonomous individual, and discussing the problems that still remain in the study of animal ethics. (shrink)

Background:Moral distress is a complex phenomenon frequently experienced by critical care nurses. Ethical conflicts in this practice area are related to technological advancement, high intensity work environments, and end-of-life decisions.Objectives:An exploration of contemporary moral distress literature was undertaken to determine measurement, contributing factors, impact, and interventions.Review Methods:This state of the science review focused on moral distress research in critical care nursing from 2009 to 2015, and included 12 qualitative, 24 quantitative, and 6 mixed methods studies.Results:Synthesis of the scientific literature revealed (...) inconsistencies in measurement, conflicting findings of moral distress and nurse demographics, problems with the professional practice environment, difficulties with communication during end-of-life decisions, compromised nursing care as a consequence of moral distress, and few effective interventions.Conclusion:Providing compassionate care is a professional nursing value and an inability to meet this goal due to moral distress may have devastating effects on care quality. Further study of patient and family outcomes related to nurse moral distress is recommended. (shrink)

Trolley problems have been used in the development of moral theory and the psychological study of moral judgments and behavior. Most of this research has focused on people from the West, with implicit assumptions that moral intuitions should generalize and that moral psychology is universal. However, cultural differences may be associated with differences in moral judgments and behavior. We operationalized a trolley problem in the laboratory, with economic incentives and real-life consequences, and compared British and Chinese samples on moral behavior (...) and judgment. We found that Chinese participants were less willing to sacrifice one person to save five others, and less likely to consider such an action to be right. In a second study using three scenarios, including the standard scenario where lives are threatened by an on-coming train, fewer Chinese than British participants were willing to take action and sacrifice one to save five, and this cultural difference was more pronounced when the consequences were less severe than death. (shrink)

In this paper I explore the relationship between social epistemology and relativism in the context of feminist epistemology. I do this by focusing on one particular branch of feminist epistemology - a branch known as standpoint theory - and investigating the connection between this view and epistemic relativism. I begin by defining both epistemic relativism and standpoint theory, and by briefly recounting the standard way that the connection between these two views is understood. The literature at the moment focuses on (...) an aspect of standpoint theory called the epistemic advantage thesis, and on an aspect of relativism which has been called equality. I then show that the connection between relativism and standpoint theory actually turns on a different aspect of standpoint theory, known as the standpoint thesis, and on an aspect of relativism which has been called non-neutrality. I argue that shifting our attention to these other aspects reveals that standpoint theory is clearly and unavoidably relativist, but that this isn’t a problem - standpoint theory can capture everything that it set out to, even on a relativist understanding of the view. (shrink)

The diagnostic category of borderline personality disorder (BPD) has come under increasing criticism in recent years. In this paper, we analyze the role and impact of epistemic injustice, specifically testimonial injustice, in relation to the diagnosis of BPD. We first offer a critical sociological and historical account, detailing and expanding a range of arguments that BPD is problematic nosologically. We then turn to explore the epistemic injustices that can result from a BPD diagnosis, showing how they can lead to experiences (...) of testimonial injustice which impede patient engagement in meaning-making activities, thereby undermining standard therapeutic goals. We conclude by showing how our arguments bolster ongoing efforts to replace the diagnostic category of BPD with alternatives such as complex post-traumatic stress disorder. (shrink)

Homeopathy is over 200 years old and is still experiencing an uninterrupted influx of new practitioners and patients. Many patients and therapists swear by this "alternative healing method", which in some countries is even financed by health insurances. This seems completely incomprehensible to critics: For them it is clearly evident that homeopathy is hopelessly unscientific and has at best a placebo effect. The positions of supporters and opponents seem to be just as immutable as they are incompatible. This book answers (...) some essential and fascinating questions: What remains of the founding ideas of homeopathy in 21st century medicine? Does it really work and, if so, how? Which of the original theories can we still apply today with a clear conscience and use for the benefit of patients and the healthcare system? Where does homeopathy have its limits and does it indeed need to be critically reconsidered and evaluated? The author has dealt with the points of criticism for years, but at the same time also takes seriously the wishes and concerns of patients who often feel insufficiently cared for by conventional medical practice. Against the background of her own personal history, her book attempts to bridge the gap between these two traditionally opposing camps. (shrink)

Defences of perspectival realism are motivated, in part, by an attempt to find a middle ground between the realist intuition that science seems to tell us a true story about the world, and the Kuhnian intuition that scientific knowledge is historically and culturally situated. The first intuition pulls us towards a traditional, absolutist scientific picture, and the second towards a relativist one. Thus, perspectival realism can be seen as an attempt to secure situated knowledge without entailing epistemic relativism. A very (...) similar motivation is behind feminist standpoint theory, a view which aims to capture the idea that knowledge is socially situated, whilst retaining some kind of absolutism. Elsewhere I argue that the feminist project fails to achieve this balance; its commitment to situated knowledge unavoidably entails epistemic relativism (though of an unproblematic kind), which allows them to achieve all of their feminist goals. In this paper I will explore whether the same arguments apply to perspectival realism. And so I will be asking whether perspectival realism too is committed to an unproblematic kind of relativism, capable of achieving scientific goals; or, whether it succeeds in carving out a third view, between or beyond the relativism/absolutism dichotomy. (shrink)

Game theory is central to modern understandings of how people deal with problems of coordination and cooperation. Yet, ironically, it cannot give a straightforward explanation of some of the simplest forms of human coordination and cooperation--most famously, that people can use the apparently arbitrary features of "focal points" to solve coordination problems, and that people sometimes cooperate in "prisoner's dilemmas." Addressing a wide readership of economists, sociologists, psychologists, and philosophers, Michael Bacharach here proposes a revision of game theory that resolves (...) these long-standing problems. In the classical tradition of game theory, Bacharach models human beings as rational actors, but he revises the standard definition of rationality to incorporate two major new ideas. He enlarges the model of a game so that it includes the ways agents describe to themselves their decision problems. And he allows the possibility that people reason as members of groups, each taking herself to have reason to perform her component of the combination of actions that best achieves the group's common goal. Bacharach shows that certain tendencies for individuals to engage in team reasoning are consistent with recent findings in social psychology and evolutionary biology. As the culmination of Bacharach's long-standing program of pathbreaking work on the foundations of game theory, this book has been eagerly awaited. Following Bacharach's premature death, Natalie Gold and Robert Sugden edited the unfinished work and added two substantial chapters that allow the book to be read as a coherent whole. (shrink)

Universities and other research institutions are increasingly providing additional training in research integrity to improve the quality and reliability of research. Various training courses have been developed, with diverse learning goals and content. Despite the importance of training that focuses on moral character and professional virtues, there remains a lack of training that adopts a virtue ethics approach. To address this, we, a European Commission-funded consortium, have designed a train-the-trainer programme for research integrity. The programme is based on (1) virtue (...) ethics, (2) the ethos of science, (3) learning by doing and (4) learner-centred teaching. The blended learning programme combines e-learning modules with participatory group sessions. Trainers are taught how to guide researchers through a series of structured exercises for fostering reflection on scientific virtues, and how to promote understanding and application of the European Code of Conduct for Research Integrity. Trainers are provided with adaptable tools and resources that can be used and combined in different ways. The programme implementation began in Spring 2020 and 470 trainers have participated to date. When trainers were asked to grade – between 0 (very bad) and 10 (excellent) – the e-learning modules and the participatory exercises, 60% scored a grade 8 or higher (median = 8, IQR = 2) for the e-learning modules, whereas 80% scored a grade 8 or higher (median = 9, IQR = 1) for the participatory exercises. A majority felt that the training helped them as a trainer to learn about ways to organise and teach a research integrity course (82%) and would recommend the interactive exercises to others (92%). Trainers have educated over 3300 researchers in Europe using our virtue-based approach. The VIRT2UE train-the-trainer programme fosters research integrity by providing trainers with exercises and tools which enable them to stimulate the development of good researchers across Europe. (shrink)

There have been multiple factors involved in the decline of the anatomy course’s central role in medical education over the last century. The course has undergone a multitude of changes, in large part due to the rise in technology and cultural shifts away from physical dissection. This paper argues that, as the desire of medical schools to introduce clinical experiences earlier in the curriculum increased, anatomy courses began implementing changes that would align themselves with the shifting culture towards incorporating humanistic (...) values early on in the medical curriculum. One of these changes, argued as a product of this shift, included calling a cadaver a ‘patient’ and introducing the cadaver as a student’s ‘first patient’. This change has been seen in different universities and textbooks. This paper argues that the use of the words ‘patient’ to describe the cadaver in order to promote principled habits in medical students may in fact create an environment that does the opposite. By equating an environment in which the subject of dissection is lifeless and incapable of participation, and the space is discouraging of emotions and conducive to untested coping mechanisms to the clinical environment through using the word ‘patient’, values like detached concern, a controversial practice in medicine, can be implicitly encouraged. An ethical analysis of the use of the word ’patient’ to describe the cadaver shows that this practice can promote unethical habits in students and that changing this aspect of anatomy lab culture could improve ethical dispositions of future physicians. (shrink)

Background:Ethical conflict and subsequent nurse moral distress and burnout are common in the intensive care unit (ICU). There is a gap in our understanding of nurses’ perceptions of how organizational resources support them in addressing ethical conflict in the intensive care unit.Research question/objectives/methods:The aim of this qualitative, descriptive study was to explore how nurses experience ethical conflict and use organizational resources to support them as they address ethical conflict in their practice.Participants and research context:Responses to two open-ended questions were collected (...) from critical care nurses working in five intensive care units at a large, academic medical center in the Midwestern region of the United States.Ethical considerations:This study was approved by the Institutional Review Board at the organization where the study took place.Findings:Three main interwoven themes emerged: nurses perceive (1) intensive care unit culture, practices, and organizational priorities contribute to patient suffering; (2) nurses are marginalized during ethical conflict in the intensive care unit; and (3) organizational resources have the potential to reduce nurse moral distress. Nurses identified ethics education, interprofessional dialogue, and greater involvement of nurses as important strategies to improve the management of ethical conflict.Discussion:Ethical conflict related to healthcare system challenges is intrinsic in the daily practice of critical care nurses. Nurses want to be engaged in discussions about their perspectives on ethical conflict and play an active role in addressing ethical conflict in their practice. Organizational resources that support nurses are vital to the resolution of ethical conflict.Conclusion:These findings can inform the development of interventions that aim to proactively and comprehensively address ethical conflict in the intensive care unit to reduce nurse moral distress and improve the delivery of patient and family care. (shrink)

In her book Extended Rationality: A Hinge Epistemology (2015), Annalisa Coliva puts forward an anti-sceptical proposal based on the idea that the notion of rationality extends to the unwarrantable presuppositions “that make the acquisition of perceptual warrants possible” (2015: 150). These presuppositions are commonly the target of sceptical arguments, and by showing that they are on the one hand unwarrantable, but on the other are constitutive components of rationality itself, she reveals that they are beyond rational doubt and thus avoids (...) scepticism. Part of Coliva’s defence of using extended rationality in this way involves distancing it from relativist interpretations, which she describes as “devastating” (2015: 120). She proposes two ways that someone might attempt to formulate epistemic relativism from her extended rationality view, and argues that both would be unsuccessful because they require describing alternative conceptions of rationality which are “unintelligible” (in the first case), or “inconceivable” (in the second). The superficial claim of this chapter is that Coliva’s arguments, as they stand, are insufficient to dismiss relativism. She fails to show that the conception of rationality needed for the first formulation of relativism is unintelligible, and overestimates the significance of the second formulation’s conception turning out to be inconceivable. But I also highlight a deeper problem: neither formulation follows a realistic blueprint for relativism, and so these were the wrong possibilities to consider in the first place. To address this issue, I propose a third, more plausible, way in which someone might attempt to formulate relativism on the basis of Coliva’s account. I leave open whether this strategy is successful, or whether a version of Coliva’s criticisms apply to it too. (shrink)

Drawing on recent findings in the cognitive and neurosciences, this article discusses how people manage to predict each other’s actions, which is fundamental for joint action. We explore how a common coding of perceived and performed actions may allow actors to predict the what, when, and where of others’ actions. The “what” aspect refers to predictions about the kind of action the other will perform and to the intention that drives the action. The “when” aspect is critical for all joint (...) actions requiring close temporal coordination. The “where” aspect is important for the online coordination of actions because actors need to effectively distribute a common space. We argue that although common coding of perceived and performed actions alone is not sufficient to enable one to engage in joint action, it provides a representational platform for integrating the actions of self and other. The final part of the paper considers links between lower‐level processes like action simulation and higher‐level processes like verbal communication and mental state attribution that have previously been at the focus of joint action research. (shrink)

Enclosed is a guidebook for philanthropists, advocates, and policymakers who want to do the most good possible. This book introduces the philosophy of “longtermism,” the idea that it is particularly important that we act now to safeguard future generations. -/- The future is vast in scale: depending on our choices in the coming centuries, the future could stretch for eons or it could dwindle into oblivion, and be inordinately good or inordinately bad. And yet future generations are utterly disenfranchised in (...) the world today: they cannot participate in our markets, our movements, or our civil society. This presents 21st Century philanthropists with a historically unprecedented opportunity to do good by protecting the long-term future. -/- The essays within are from the pioneers who have developed the intellectual foundations of longtermism, as well as the experts and advocates who are now putting it into practice. Readers will hear the case for longtermism from professors at the University of Oxford and Longview’s own founders; longtermist policy proposals from political philosophers, members of the House of Lords, and the All-party Parliamentary Group for Future Generations; the case for work on biosecurity, artificial intelligence, and climate change from leading experts; and the first ever essay on longtermist cultural change from the former Chief of Cabinet to the Finnish President. -/- Together, these essays chart the path forward toward maximising the good that we do for our grandchildren, our grandchildren’s grandchildren, and every generation beyond. (shrink)

This book engages with some of the most pressing ethical issues that arise from the use of animals in various business practices, providing interdisciplinary approaches to improving the nonhuman and human lives in animal-related industries. The chapters in this volume provide conceptual, theoretical and practical analyses of these issues that will shape the future direction of business ethics to more fully reflect the impacts and implications of animal-based businesses on society, its members, and nature. The authors in this volume engage (...) with topics including animal suffering and emotions, the commodification of animals, vegetarian and vegan businesses and diets, technological innovations such as gene editing and lab-cultured meat, as well as captivity, corporate disclosure of animal welfare policies, and the possibility of humane jobs as well as the consideration of animals as stakeholders. (shrink)

In the literature of collective intentions, the ‘we-intentions’ that lie behind cooperative actions are analysed in terms of individual mental states. The core forms of these analyses imply that all Nash equilibrium behaviour is the result of collective intentions, even though not all Nash equilibria are cooperative actions. Unsatisfactorily, the latter cases have to be excluded either by stipulation or by the addition of further, problematic conditions. We contend that the cooperative aspect of collective intentions is not a property of (...) the intentions themselves, but of the mode of reasoning by which they are formed. We analyse collective intentions as the outcome of team reasoning, a mode of practical reasoning used by individuals as members of groups. We describe this mode of reasoning in terms of formal schemata, discuss a range of possible accounts of group agency, and show how existing theories of collective intentions fit into this framework. (shrink)

Mainstream epistemologists don’t tend to discuss feminist epistemologies. They often don’t mention them in introductory courses or textbooks, and they almost invariably don’t take themselves to work on them. This is probably due to a suspicion that ‘feminist’ epistemologies are clouded by political motivations. In this paper I will argue two things. First, that this suspicion is misguided – a number of ‘mainstream’ epistemologists (specifically, hinge epistemologists), are in fact doing work which is entirely compatible with feminist epistemologies, and the (...) ‘extra ingredient’ required to turn a hinge epistemology into a feminist epistemology needn’t involve political motivations. And second, that bringing feminist epistemologies into the mainstream can benefit hinge epistemologies – by adding the extra ingredient which turns a hinge epistemology into a feminist epistemology, hinge epistemologists increase the motivations they can appeal to in support of their responses to scepticism. (shrink)

Decision theory explains weakness of will as the result of a conflict of incentives between different transient agents. In this framework, self-control can only be achieved by the I-now altering the incentives or choice-sets of future selves. There is no role for an extended agency over time. However, it is possible to extend game theory to allow multiple levels of agency. At the inter-personal level, theories of team reasoning allow teams to be agents, as well as individuals. I apply team (...) reasoning at the intra-personal level, taking the self as a team of transient agents over time. This allows agents to ask, not just “what should I-now do?’, but also ‘What should I, the person over time do?’, which may enable agents to achieve self-control. The resulting account is Aristotelian in flavour, as it involves reasoning schemata and perception, and it is compatible with some of the psychological findings about self-control. (shrink)

Feminist epistemologies hold that differences in the social locations of inquirers make for epistemic differences, for instance, in the sorts of things that inquirers are justified in believing. In this paper we situate this core idea in feminist epistemologies with respect to debates about social constructivism. We address three questions. First, are feminist epistemologies committed to a form of social constructivism about knowledge? Second, to what extent are they incompatible with traditional epistemological thinking? Third, do the answers to these questions (...) raise serious problems for feminist epistemologies? We argue that some versions of two of the main strands in feminist epistemology – feminist standpoint theory and feminist empiricism – are committed to a form of social constructivism, which requires certain departures from traditional epistemological thinking. But we argue that these departures are less problematic than one might think. Thus, (some) feminist epistemologies provide a plausible way of understanding how (some) knowledge might be socially constructed. (shrink)

In Medical Ethics, the editors have developed a completely different type book, focusing upon issues not ordinarily dealt with in texts on bioethics.

In this paper I make the case for a feminist hinge epistemology in three steps. My first step is to explain hinge epistemologies as contemporary epistemologies that take Wittgenstein’s work in On Certainty as their starting point. My second step is to make three criticisms of this literature as it currently stands. My third step is to introduce feminist epistemologies, which argue that social factors like race and gender affect what different people and groups justifiably believe, and argue that developing (...) a feminist hinge epistemology is both plausible and desirable. (shrink)

Different views on the connection between relativism and feminist epistemologies are often asserted but rarely are these views clearly argued for. This has resulted in a confusingly polarised debate, with some people convinced that feminist epistemologies are committed to relativism (and that this is a reason so be suspicious of them) whilst others make similar criticisms of anti-feminist views and argue that relativism has no place in feminist epistemologies. This chapter is an attempt to clarify this debate. I begin by (...) asking the question “are feminist projects and goals best served by relativism, or by absolutism?” I then sketch out four broad positions one could take on the answer to this question, and evaluate arguments for each one. In the end I conclude that feminist projects can, at least sometimes, be served by relativism, and that the claim they can be served by anti-relativism is under-supported. (shrink)

Participatory deliberation, whereby diverse experts and publics collectively engage in decision‐making, can ensure a more informed and just decision by centering historically marginalized perspectives and engaging a spectrum of value systems. Broad and diverse participation is crucial for the equitable distribution of risks and benefits resulting from complex and uncertain decisions such as environmental gene editing. From an ethical position that gives intrinsic value to the nonhuman and recognizes the interconnectedness of species across generations, we argue that deliberation over environmental (...) gene editing must include the voice of nature and the voice of future generations. Inclusion of these key participant groups can encourage reflection on the human relationship with nature and help safeguard intergenerational equity of decisions reached. By drawing from the legal rights of nature movement, the Boardman River Dams Project, and methods for representative participation, we offer strategies for inclusion of nonhuman nature and future generations in deliberative processes about environmental gene editing and other crucial decisions about our shared environments. (shrink)

Research Ethics, Volume 18, Issue 3, Page 210-225, July 2022. Interview-based research in multilingual situations can present researchers with specific ethical challenges relating to language-based power play, data handling and presentation. Studies indicate favouring the L1 as an interviewing language may produce better quality data, but external pressures can favour English as the dominant research language. This article examines researcher perceptions and experiences of the ethical consequences of language choice and the practical issues involved. Interviews were conducted with five European (...) researchers working on an interview-based project with experiences of diverse interviewing scenarios. The four moral principles of respect for autonomy, justice, beneficence and non-maleficence were used as a framework for analysis. The analysis revealed a nuanced picture of ethical issues in both L1- and English-oriented scenarios. This included potential misrepresentation and deculturalisation of the data in the former, and language-based power asymmetries in the latter. The findings highlight the importance of documenting ethics-related methodological details of language use, and advocates publication practices favouring the inclusion and foregrounding of L1 data. (shrink)

This paper proposes a refocusing of consent for clinical genetic testing, moving away from an emphasis on autonomy and information provision, towards an emphasis on the virtues of healthcare professionals seeking consent, and the relationships they construct with their patients. We draw on focus groups with UK healthcare professionals working in the field of clinical genetics, as well as in-depth interviews with patients who have sought genetic testing in the UK’s National Health Service. We explore two aspects of consent: first, (...) how healthcare professionals consider the act of ‘consenting’ patients; and second how these professional accounts, along with the accounts of patients, deepen our understanding of the consent process. Our findings suggest that while healthcare professionals working in genetic medicine put much effort into ensuring patients’ understanding about their impending genetic test, they acknowledge, and we show, that patients can still leave genetic consultations relatively uninformed. Moreover, we show how placing emphasis on the informational aspect of genetic testing is not always reflective of, or valuable to, patients’ decision-making. Rather, decision-making is socially contextualised – also based on factors outside of information provision. A more collaborative on-going consent process, grounded in virtue ethics and values of honesty, openness and trustworthiness, is proposed. (shrink)